JOHN W. SEDWICK, Senior District Judge.
At docket 40, Defendant Bankers Life and Casualty Company ("Bankers" or "Defendant") filed a motion asking the court to grant summary judgment in its favor as to the breach-of-contract action filed by Plaintiff Amber Dunford ("Plaintiff"). Defendant's statement of facts and supporting documents are filed at docket 41, with a sealed exhibit filed at docket 43. Plaintiff responds at docket 45, with her statement of facts and supporting documents at docket 45. Defendant replies at docket 49 and includes a response to Plaintiff's statement of facts at docket 51. Oral argument was heard on August 22, 2016.
Plaintiff's breach-of-contract claim against Bankers stems from its rescission of a life insurance policy it issued on the life of Tyler Dunford ("Tyler"), Plaintiff's now-deceased husband (Plaintiff and Tyler are collectively referred to as "the Dunfords"). Plaintiff married Tyler in November of 2012 and shortly thereafter began looking for life insurance for her husband. At the time, she was aware that Tyler had previous DUIs and was on house arrest, and she knew that her husband had suffered a broken back. She filled out an application with two other insurance companies and disclosed her husband's known history and was denied. Plaintiff alleges that she was referred to Bankers' agent and employee Clifton McGee ("McGee"). She was told that he would issue life insurance to people with "histories." Plaintiff spoke to McGee on the telephone and alleges that she disclosed Tyler's history of DUIs and his prior back fracture. She alleges that she disclosed that they had been denied by other insurance companies.
McGee met with the Dunfords in February of 2013. Plaintiff alleges she was present for the entire meeting, save for a few moments when she went to get her checkbook. McGee filled out applications on behalf of the Dunfords for a $300,000 term life policy and also a temporary $25,000 whole life policy to cover the Dunfords while the application for the term life policy was pending. Plaintiff alleges McGee did not ask them the qualifying questions on the applications and instead told them that he believed "everybody deserves a second chance."
The application for the term life policy required a paramedical examination as well. The exam took place in March of 2013 and was conducted by a paramedical professional working for a different company, EMSI. Neither Plaintiff nor McGee was present for the exam. As part of the examination, the paramedical examiner used a questionnaire provided by Bankers to question Tyler about his health history.
The term policy was issued on April 1, 2013. Plaintiff received the policy on April 11, 2013. Tyler died in an accident in early May of 2013, and Plaintiff filed a claim for life insurance with Bankers. As a result of its investigation into the claim, Bankers obtained Tyler's medical and criminal records and discovered that Tyler's recent history included not only DUIs and a broken back, which Plaintiff alleges had been disclosed to McGee, but also a history of alcohol and drug dependency, abuse, and treatment, as well as a history of anxiety, depression, and suicide attempts. Plaintiff only learned about Tyler's drug and mental health history as a result of Bankers' investigation and confirms that this additional history was not disclosed to McGee. Bankers rescinded the term life policy in December of 2013 based on Tyler's material misrepresentations about his health and criminal history. Plaintiff thereafter filed this action for breach of contract.
Summary judgment is appropriate where "there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law."
The moving party has the burden of showing that there is no genuine dispute as to any material fact.
Bankers argues that its rescission of the insurance policy was proper under the policy and A.R.S. § 20-1109 because Tyler concealed and misrepresented his criminal and medical history during the application process. The statute relied on by Bankers provides, in relevant part, that a misrepresentation, omission, or concealment of facts in an insurance application cannot prevent recovery under the policy unless: (1) it is fraudulent; (2) it is material to the acceptance of the risk; and (3) the insurer would not have issued the policy or provided coverage if the "true facts had been made known to the insurer."
Bankers does not need to show an actual intent to deceive in order to show fraud under the rescission statute. Legal fraud will suffice. "Legal fraud exists if the question asked in an insurance application: (1) is one where the facts are within the personal knowledge of the insured; (2) are such that the insurer would naturally have contemplated that the answers represented the actual facts; and (3) the answers are false."
It is undisputed that Tyler's life insurance application contained questions regarding his criminal history, prior injuries, depression, and drug use and that the questions were answered incorrectly. However, Tyler's failure to disclose his full history is complicated by McGee's role in completing the application. "Knowledge of an insurance agent is, as a matter of law, knowledge of the insurance company, whether or not the information is actually communicated to the insurance company by its agent."
However, McGee did not know the full extent of Tyler's history. He was not told about Tyler's drug abuse and history of depression. There were questions on the form that specifically asked about such topics and were answered falsely. For example, there was a question asking whether Tyler had used "cocaine, marijuana, heroin, amphetamines, barbiturates, or other drugs except as prescribed by a physician" and a question asking whether he "had or been advised to have treatment or counseling for alcohol or drug abuse."
Tyler's signature is on the application and by signing the application he was supposedly verifying that the statements were correct. Generally, an applicant is under a duty to examine the answers set forth in the application and becomes bound by the answers as recorded if he or she does not subsequently correct them.
The February meeting with McGee, however, was only a portion of the application process. It is undisputed that McGee informed the Dunfords that Tyler would have to pass a medical exam as part of the application process. The exam occurred over a month later, in March of 2013. It did not involve McGee. Rather, Melissa Bebee, a medical professional working for a separate company, EMSI, conducted the exam. The exam consisted in part of another medical history questionnaire. The questionnaire states that it is "Part II" of the application process and that it consists of "statements to [the] medical examiner." It directs the paramedical professional to complete the form.
As noted above, the court cannot impute knowledge to Bankers as to Tyler's past drug use and mental health history because McGee did not know about those specific issues. Moreover, unlike the situation with the initial application that Tyler signed the month before, there is nothing in the record to suggest that a Bankers's agent was responsible for the false answers on the medical questionnaire, and there is nothing in the record to show that McGee's conduct on the initial application somehow tainted the medical portion of the application process. That is, there is nothing in the record to show that McGee had anything to do with the subsequent medical exam. In fact, the record only shows that McGee did not communicate with the paramedical professional who conducted the exam.
The medical questionnaire is admissible evidence. Under A.R.S. § 20-1108 an application for insurance is not admissible unless "a copy of the application was attached to or otherwise made a part of the policy when issued and delivered." Here, Bankers presents evidence to show that the policy packet assembled for the Dunfords included the initial application and the paramedical exam form.
During oral argument Plaintiff clarified that she was not challenging the admissibility of the questionnaire when she argued that Bankers did not present any evidence to verify how it was filled out. Rather, Plaintiff contends that she was questioning the probative value of the questionnaire. That is, she argues that the jury should weigh the questionnaire along with all the other evidence when determining whether Tyler fraudulently answered insurance application questions. The court disagrees. It is undisputed that the medical questionnaire form contains material false answers. The form was signed by Tyler, and Plaintiff confirms that the signature on the page is indeed Tyler's.
To the extent Plaintiff argues that the probative value of the questionnaire is lessened when viewed in light of McGee's prior misconduct, the court finds that the medical examination was sufficiently separate from the initial application process. The only evidence on the issue shows that McGee was not involved in the subsequent medical exam and did not suggest or advise Tyler to hide or falsify answers during the medical exam. Indeed, as noted above, Plaintiff testified that she did not believe McGee suggested that they lie about his history but, rather, that Bankers would insure someone with Tyler's history. Bankers has met its burden of showing that Tyler made material, false statements on an insurance application free from the misconduct of McGee.
Plaintiff also asks the court to apply the doctrine of reasonable expectations to prevent Bankers from rescinding the life insurance policy. She argues that since McGee informed the Dunfords that Tyler would be able to get a policy despite his knowledge of Tyler's DUI history and back injuries, McGee created an objective impression of coverage in the mind of a reasonable insured. Therefore, she argues that Bankers should be bound to cover Tyler's life despite any express policy terms. The reasonable expectations doctrine is inapplicable here. The doctrine is applied to situations where there is a dispute about the extent of coverage under a policy's standardized terms that customers would not be expected to read and over which they have no real negotiating power.
Based on the preceding discussion, Defendant's motion for summary judgment is GRANTED. Plaintiff's complaint is dismissed, and the clerk is directed to close the case.